Gates foundation: Is it on right path?

The world's richest private foundation is committed to fight poverty, hunger and eradicate killer diseases like malaria and HIV Aids.

The endowment fund of the Bill & Melinda Gates Foundation is a staggering US$36.4 billion.

Gates ( left in photo ) founded the software company Microsoft, and is among the wealthiest people in the world.

A priority of the foundation is to fight polio and fund research for a vaccine to eradicate malaria. Is it sufficient to save millions of lives lost through poverty and corruption?

The foundation also provides development funds for small farmers in Africa, and computers with internet access to countries like Chile.

But are the foundation's strategies right in waging war against killer diseases, hunger and poverty?

Malaria, a leading cause of ill health and death, is endemic in 130 countries. Every 30 seconds a child dies of malaria somewhere in the world. Malaria is a disease of poverty. Almost 60 per cent of all malaria deaths occur among the poorest 20 per cent of people.

The poor cannot afford proper housing, mosquito nets and medicines. Additionally, malaria parasites are resistant to existing medicinal drugs.

The Bill & Melinda Gates Foundation is pouring millions of dollars for research into a vaccine to eradicate malaria.

Volunteers are already testing a potential vaccine which the foundation hopes will be available by 2014.

  Public-private partnerships

Several years ago, I had an opportunity to be a trainer for a health advocacy training programme for health workers from Africa and India involved in the work to combat malaria and other diseases.

I poured through evaluation reports on programmes, particularly public-private partnerships (PP) against malaria.

During the training workshop, grassroots participants provided insightful aspects on the impact of PPs in anti-malaria programmes as part of WHO's efforts to roll back malaria (RBM).

Under the RBM programme, pharmaceutical companies provided anti-malaria drugs at reduced costs as well as insecticide-treated mosquito nets for beds.

But are these interventions sustainable? The reports from grassroots health workers in Tanzania, Uganda, South Africa and India suggest that there are numerous weaknesses in public private partnerships and donor funded programmes to eradicate malaria and other poverty related diseases.

Donor funds intended for purchase of drugs and insecticide-treated mosquito nests do not necessarily reach those who need them most.

The poor cannot afford to purchase the drugs or the mosquito nets even at reduced costs.

The reports, studies and presentations I saw indicated that the global PP initiatives in health do not make real significant and sustainable efforts to eradicate poverty related diseases.

Donor funds are often insufficient to address the causal conditions that are at the root of illness like malaria such as poverty, corruption and political instability.

One of my favourite films is The Constant Gardener , starring Ralph Fiennes. The film graphically captures the devastating effects of corruption and power of pharmaceutical companies and politicians in Kenya.

Watch it and you will understand the consequences of corruption on health.

 Go beyond research

The work of the Gates Foundation on health and development will need to look beyond research, and vaccines for diseases like malaria, HIV Aids etc. For example, providing drugs and vaccines alone is unlikely to have long term impact in the eradication of endemic diseases.

The solution lies in strengthening national and public health care systems, which are the main source of health care services for the poor.

If these systems are weak, understaffed and under-resourced, they will be unable to manage donor expectations as well as their normal day to day activities including emergencies at the local level.

The poor desperately need the daily basic services provided by local health centres in many developing countries.

Have national, health regulations been harmonised to meet the needs and expectations of philanthropic health and development activities of the Gates Foundation, for example?

Without harmonising regulations, putting in place mechanisms and structures for donor based projects, they will have to compete with local programmes or vice-versa.

For example, if there is an outbreak of diarrhoeal diseases, health workers will need to attend to this emergency and put aside work on malaria.

A common problem encountered by recipients of donor supported programmes is the shortage of funds. While donors provide financial support for activities, they are reluctant to pay staff salaries.

NGO managed health programmes constantly face this challenge and as a result are understaffed and overburdened.

Governance issues like transparency, accountability and decision-making processes can seriously impede progress of donor-driven health projects.

The disclosure of information on financial decisions, drug and vaccine donations and decision-making at national levels are issues that can impede the progress in health projects funded by external donors.

Corruption in health is a major concern in many developing countries.

Will the Melinda and Gates Foundation support activities by civil society that advocate for greater transparency and accountability in the national health services delivery systems?

Has the Gates Foundation undertaken studies to access the effects of its health and development programmes on national health care systems where the Foundation's programmes are based?

Discovering the magic vaccine is owning only one weapon against the war on malaria or HIV Aids or polio.

The greater challenge is making it available to the millions who need them, but are trapped in poverty and health systems besieged by political instability and corruption.

There are existing vaccines against killer diseases like polio. Yet the children who need them do not have the access to these vaccines.

Wiping out polio

To its credit, the Gates Foundation has saved millions of lives by providing vaccines to children in several developing countries. The foundation aims to eradicate polio by 2012.

Rajeev Venkayya, the foundation's Director for Global Health Vaccine says in an interview ( Financial Times 13/11/2010), "Getting rid of polio would demonstrate to the world the art of the possible. You can wipe an entire disease off the face of the earth."

But the foundation could save even more lives by including other weapons in its war against killer diseases.

Global programmes against poverty and corruption will need to be funded along side vaccine research. The vaccines and medicines may not reach the victims of poverty and corruption , who need them most.

Without addressing corruption and poverty (which will include a whole gamut of issues like unfair trade), it would not be possible to eradicate killer diseases like malaria and tuberculosis.

I wonder if Bill Gates, like many wealthy philanthropists has found an arena only where his energy, expertise and money could be directed after retirement?

Is Gates ready to rock the boat where corrupt politicians are responsible for loss of millions of lives through poverty and diseases?

Again I am reminded that the world needs social justice philanthropy and not charity like providing medicines and food.

Gates must therefore also support programmes against corruption to save even more lives.

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JOSIE M FERNANDEZ is currently an Asian Public Intellectual Fellow, director of Philanthropy Asia, a researcher and consultant. Working on sustainability, philanthropy and anti-corruption actions are some of her current passions besides writing.